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Why We All Need Self Doubt (Even Medevac Helicopter Pilots)

January 12, 2014

As the pilot-in-command of a medevac helicopter, I am responsible for the safety and operation of everything related to the flight.

But on a recent flight, I didn’t feel “in command.” The flight wasn’t challenging because I encountered bad weather or because there was a problem with the helicopter. The problem was managing my emotions.

When you first start flying medevac, there is a lot of unfamiliar lingo used by the medical crew: elevated troponins, STEMI, Atavan. These industry specific terms enter my headset like new flavors and I roll them around my mouth trying to determine their meaning. Now three years later, I understand much of the lingo, but am still not fluent.

A Complicated Patient

Sometimes the words are common but are used in ways that are unfamiliar. Patients that are close to death are often called “complicated” or “really sick.”

Usually it takes 30-45 minutes for a crew to “package” a patient and get them ready for transport. For this particular call it took nearly two hours, a sure sign that the patient was very complicated. When the patient was finally ready to go, I helped load him into the helicopter.

The helicopter I fly, an Astar, is a small aircraft and it is often a challenging process to arrange all the IV tubing, ventilator, and medical equipment into the helicopter before we close the doors and depart. It often feels like we’re flying a Ford Festiva. The stretcher is next to me and the patient is propped up like they resting on a lounge chair at the pool. The crew, a nurse and a paramedic, tend to the patient from the back seat.

As I helped load the patient, a man who was unconscious and on a ventilator, I gazed into the patient’s unfocused blue eyes. They were the exact same shade as my Dad’s.

After we lifted for Anchorage the patient’s condition deteriorated. His blood pressure slipped lower and lower.

The Patient is Going to Die

Through my headset, I heard, “He’s going to code if we don’t increase his pressure.”

Coding is the medical term used for cardiac arrest. In my three years of flying a medevac helicopter, I haven’t ever had anyone die in-flight. I’ve also never seen CPR performed in the helicopter. Ideally, the crew has the patient stabilized enough before we lift and during transport to avoid this. Today wasn’t going to be one of those days.

It is a 38 minute flight to Anchorage, but when things start going badly, seconds feel like minutes. I coaxed more speed out of the aircraft. The increase might shave a minute off the flight time. It wasn’t much.

The crew laid the patient down and the IV tubing and sheets were pulled away exposing his fleshy, no-sun-in a-while belly in preparation for chest compressions.

The next thing I heard, “His pressure isn’t sustainable with life. He’s going to die.”

I don’t panic in crisis. It what makes me good at what I do. But this time, I couldn’t do anything. I couldn’t make the helicopter go any faster. I couldn’t make his heart continue to beat. I could only sit and listen.

When my Dad passed away, there was time to make peace with his death. But in this case, there was no time to make peace with the death of a man I didn’t even know. The seconds ticked by, crew flooding his veins with chemical cocktails designed to restore his blood pressure, I was once again reminded that the gap between life and death is very, very small.

I can isolate the crew to cut out their conversation, but in a cockpit the size of a queen-sized mattress whether you hear it or not, it is pretty obvious what is going on. I’d rather hear what the crew is saying.

When people imagine flying a medevac helicopter, they often picture screaming, bloody patients. I’ve had those, but more often the ones closest to death are the ones who have been in the ICU for days, whose bodies are shutting down one cell at a time. They are alive but not living.

If you know my story, you know I’m okay with death. People die. I sometimes even wonder if we are doing too much to prolong life. And yet, I will be eternally grateful to the medevac crews who never gave up on my Dad during his two medevac flights. Having him alive for a few more weeks gave us the time we needed to say goodbye. I think of it as the last of many, many gifts from my father.

But in that moment, I didn’t want the patient to die. Not then. Not like that.

Beat by beat, his pulse began to increase. He moved away from the thin boundary between life and death.

After we landed, the patient was whisked inside. I stood there alone on the helideck, shell-shocked. I willed myself to compartmentalize and moved on auto-pilot to fuel the aircraft in preparation for the next flight.

Filled with Self Doubt

Finished, my own veins flooded with self-doubt: I don’t know if I can do this.

What is the cost of compartmentalizing? What is the cost of being this close to death on a regular basis?

I felt a tiny peice of my soul crumble.

Nothing to do but keep moving, I went downstairs and grabbed an orange juice from the hospital’s EMS provider’s minifridge figuring a blood-sugar-boost might help. There was a paramedic in the office.

“Hey,” he said, “How’s it going?”

“Alright,” I said looking into his eyes.

What I wanted to say was, “I know what you’ve seen. I’ve seen it too. And I’m scared. I’m scared for that man and his family and for not being able to do anything. I’m afraid I can’t do this, even though it is a job I love.”

Letting Go of Compartmentalizing

Later that night, I finally had the opportunity to let go of the compartmentalizing and weep. As the tears flowed, I wondered, why was this one so difficult?

Was it because there wasn’t anything I could do?

Should there be a mechanical problem with the helicopter, I know my mind would be busy determining the best course of action, troubleshooting the problem, and flying the aircraft. I wouldn’t have time to worry about dying. In this reversed situation, the crew would be unable to do much besides sit and listen and hope the outcome would be alright.

Perhaps we are all just a passenger in life. Perhaps there is nothing to do ever.

Was it because the man’s eyes were so much like my father’s?

I still feel the loss of my Dad. It doesn’t hurt all the time like it once did, but it still can feel so crippling that I want to sink to my knees and sob. Sometimes I do.

Choosing a Powerful Story

Here’s what I decided: I want to be a pilot that feels.

I don’t ever want to get to the point where I’m so calloused I no longer feel. Because although I may feel intense sadness, but I also feel intense joy. With this job, I’m more grateful for life than I’ve ever been.

Self-doubt and fear and sadness are my own internal gauges. So are happiness and joy and delight. Emotions are indicators that we are living.

Fewer emotions = less alive.

We may have moments where we think we can’t do something. But we can and we do.

We do achieve our dreams.

We do manage the loss of a loved one.

We do things that once seemed impossible.

But it isn’t always easy or comfortable.

Earlier I said, that the problem with the flight was managing my own emotions. I’m changing that story, managing my emotions was the best part of that flight.

Being close to death makes me more alive. I want to be close. Close to life, close to death, close to you. Living.

If this post resonated with you, please share it. What are you close to in your own life?

About Lorena

Lorena Knapp is a helicopter pilot and medevacs patients to nearby hospitals. Prior to her aviation career, Lorena taught elementary school in the Anchorage School District. She coordinates The Professional Pilot Leadership Initiative, a formal mentoring program for professional pilots through The Ninety-Nines, an organization for women pilots. Between medevac flights, she is a freelance writer for Alaska Magazine and blogs about living a Big Life today at BigStateBigLife.com. Whether through writing, teaching or flying, Lorena loves inspiring others to achieve their dreams.